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Patients A total of 2,140 patients receiving ICU care between 1999 and 2001.

Interventions The remote care program used intensivists and physician extenders to provide supplemental monitoring and management of ICU patients for 19 hrs/day (noon to 7 am) from a centralized, off-site facility (eICU). Supporting software, including electronic data display, physician note- and order-writing applications, and a computer-based decision-support tool, were available both in the ICU and at the remote site. Clinical and economic performance during 6 months of the remote intensivist program was compared with performance before the intervention.

Conclusions The addition of a supplemental, telemedicine-based, remote intensivist program was associated with improved clinical outcomes and hospital financial performance. The magnitude of the improvements was similar to those reported in studies examining the impact of implementing on-site dedicated intensivist staffing models; however, factors other than the introduction of off-site intensivist staffing may have contributed to the observed results, including the introduction of computer-based tools and the increased focus on ICU performance. Although further studies are needed, the apparent success of this on-going multiple-site program, implemented with commercially available equipment, suggests that telemedicine may provide a means for hospitals to achieve quality improvements associated with intensivist care using fewer intensivists.

From VISICU, Baltimore, MD (MJB, BAR, MD, DJS); the Departments of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (MJB, BAR); Sentara Healthcare, Norfolk, VA (GB, GY, RH); the Department of Medicine, New York University School of Medicine, New York, NY (MD); Clinical Family and Community Medicine, Eastern Virginia School of Medicine, Norfolk, VA (GY); the Department of Anesthesiology and Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA (DJS); and Cap Gemini Ernst and Young (PT, DWP).

Supported, in part, by VISICU, which paid for the costs of the Cap Gemini Ernst and Young financial analysis.